key: cord-1004394-9xpccasc authors: Feleke, Dejen Getaneh; Chanie, Ermiase Sisay; Tilaye, Birara Ayichew; Mesfin, Demeke; Bayih, Biniam Munye; Bayih, Wubet Alebachew; Tassew, Sheganew Fetene; Asnakew, Sentayehu; Berlie, Tekalign Amera; Dires, Tadela; Dagnaw, Enyew; Tadesse, Tesfaye Yimer title: Knowledge, Attitude and Associated Factors toward COVID-19 among Nurses Who Work in South Gondar Zone, Hospitals, Northwest Ethiopia 2020. A multi central Institutional based cross sectional study date: 2021-07-03 journal: New Microbes New Infect DOI: 10.1016/j.nmni.2021.100914 sha: 883ba62817b83127cd95d52fc55a33794198b0ef doc_id: 1004394 cord_uid: 9xpccasc Background Coronavirus disease 2019 is an emerging respiratory disease that is caused by a novel coronavirus and was first detected in December 2019 in Wuhan, China. The world is affected by the Coronavirus Disease in 2019. In sub-Saharan Africa Including Ethiopia there is no study conducted level of Knowledge, Attitude and Associated Factors toward Coronavirus disease 2019 among Health care workers Specifically Nurses. Objective This study aims to assess the level of Knowledge, Attitude and Associated Factors toward Coronavirus disease 2019 among Nurses Who Work in South Gondar Zone, Hospitals, Northwest Ethiopia, 2020. Methods An Institution based cross-sectional study was conducted among 166 Nurses in South Gondar Zone, Ethiopia, From June 1st -30/2020. To select study participants after proportional allocation of study subjects to each Hospital, simple random sampling techniques was to be used. Data was entered into Epi info version 7.2.0.1, and exported to Statistical Package for Social Sciences window version 24 for analysis. Binary and Multivariable logistic regression was used to see the association between dependent and independent variables. Adjusted odds' ratio with 95% confidence interval was computed. P-value < 0.05 was used to declare association. Finally,; the result is presented in the form of texts, tables and graphs. Results Of 166 Nurses, 166 (100% response rate) responded to the online interview questionnaire. From 166 nurses, 57.2% of the participants were Females and 42.8% were males, 41.6 % of the respondents were between the ages of 20 and 29 years. About 84.9 % had good knowledge and 63.3% favorable attitude of COVID-19. Wearing general medical masks can prevent one from acquiring infection by theCOVID-19 virus (AOR = 0.44, 95% CI =0.005-0.362 were factors of knowledge about COVID-19. Whereas, strongly agree for Medical staffs are ready to participate in anti-epidemic in the community (AOR =0.08, 95% CI = (0.003-1.76 Where factors of attitude about COVID-19. Conclusion In this study, most of the nurses had good knowledge and favorable attitude regarding of COVID-19. Wearing general medical masks can prevent one from acquiring infection by theCOVID-19 virus were factors in association with knowledge OF nurses on COVID-19. Similarly, Medical staffs are ready to participate in anti-epidemic in the community factors association with attitudes of nurses on COVID-19. Coronavirus disease 2019 (COVID- 19) is an emerging respiratory disease that is caused by a novel coronavirus and was first detected in December 2019 in Wuhan, China (1) (2) (3) . The novel coronavirus is very similar in symptomatology to other viral respiratory infections (1, 4) . The novel COVID-19 was first reported in December 2019, as a cluster of acute respiratory illness in Wuhan, Hubei Province, China, from where it spread rapidly to over 198 countries. It was declared as a global pandemic by WHO on 12 th March 2020 (5, 6) . COVID-19 is a new disease that is a large family of viruses that are common in people and many species of animals, including camels, cattle, cats, and bats (7) . Nowadays, COVID-19 is a life-threatening agent with the worldwide spread, and it has become an international concern. Health workers, especially nurses, have close contact with infected patients and have a decisive role in infection control (8) . The newest member of the COVID-19 family has been recently identified that results in acute and severe respiratory syndrome in humans (9) . The first infected patient who had clinical manifestations such as fever, cough, and dyspnea was reported on 12 December 2019 in Wuhan, China (9, 10) . Since then, COVID-19 has spread rapidly to other countries via different ways such as airline traveling, and now, COVID-19 is the world's pandemic problem (11). COVID-19 has become a great public health concern in the world. No antiviral agents have been recommended so far and prevention is the best way to limit the infection (12, 13) . It seems that the current widespread outbreak has been partly associated with a delay in diagnosis and poor infection control procedures (14) . As of 22 th of August 2020, over 23,266,1431 cases of COVID-19 have been reported with a death toll of over 805,863 patients and 15,817,397 cases are recovered in the world (15). In Studies conducted in different countries such as, in Iran, more than half of the nurses 56.5% had good knowledge of COVID-19 (16) . And in another Study done in Iran, the overall achieved knowledge score regarding COVID-19 characteristics was 90% with 60.8% of the general population having moderate knowledge towards the disease (17) . Study Conducted in Pakistan, HCWs have good knowledge of 93.2%, positive attitude (8.43±1.78) regarding COVID-19 (18) . In a study done in Wuhan, Hubei province, China, the overall correct rate of the knowledge questionnaire was 90% (19) . Study done at Makerere University Teaching Hospitals, Uganda, Overall, 69% had sufficient knowledge, 21% had positive attitude toward COVID-19 (20) . Study J o u r n a l P r e -p r o o f Conducted at District 2 Hospital, Ho Chi Minh City, a mean score of knowledge and attitude of 8.17±1.3 (range 4-10) and 1.86±0.43 (range 1-5), respectively (21) . The outbreak of COVID-19 officially confirmed to be in Ethiopia on March 13, 2020 (22-24 Knowledge and Attitude toward COVID-19 can be affected by a multitude and interrelated factors (25) . A poor understanding of the disease among HCWs can result in delayed identification and treatment leading to rapid spread of infections. Over 100 health workers have lost their lives to COVID−19, a tragedy to the world and a barrier to fight against the disease (26) . Guidelines for HCWs and online refresher courses have been developed by WHO, CDC, and various governmental organizations in various countries to boost the knowledge and prevention strategies (27) . The battle against COVID-19 is still continuing in Ethiopia. To guarantee the final success, people's adherence to these control measures is essential, which is largely affected by their knowledge, attitudes towards COVID-19 in accordance with KA theory (28, 29) . As transmission within hospitals and protection of HCWs are important steps in the epidemic, the understanding of having enough information regarding sources, clinical manifestations, transmission routes, and prevention ways among HCWs can play roles for this gal assessment. Since nurses are in close contact with infected people, they are the main part of the infection transmission chain and their knowledge of COVID-19 prevention and protection procedures can help prevent the transmission chain. There is paucity of literature on KA of HCWs toward the COVID-19 pandemic. To our knowledge, no study has been done in sub-Saharan Africa including Ethiopia to assess KA toward COVID-19 specifically among HCWs and especially nurses to play critical roles in the prevention of COVID-19. Ethiopia is one of the most epidemic countries for COVID-19 and there is no information regarding the awareness and attitude of Ethiopian nurses about this infectious disease. Therefore, this study was aim to assess J o u r n a l P r e -p r o o f The study was being conducted in South Gondar Zone. South Gondar Zone is one of the 11 Zones of the Amhara National Regional State and has a total of 18 Woredas. Based on the information from South Gondar Zone Administrative Health Bureau, the total population in South Gondar Zone is 2,609,823, among who are a 49.9% male, and 50.1% are females. The study was conducted from June 1st -30/2020. Institutional-based cross-sectional quantitative study was conducted. All nurses working in South Gondar Zone Hospitals were the source population of the study and study populations were select Nurses working in South Gondar Zone Hospitals were the source population of the study. Nurses working in South Gondar Zone Hospitals and available during the data collection period were included in the study, and Nurses who are on Annual leave and sick during data collection were excluded from the study. The sample size is determined using a single population proportion formula using the proportion of Health workers Level of knowledge (89%) in a study conducted in China (30) with 95% confidence interval and precision level of 5%. Knowledge and Attitude toward COVID-19. Age of participants, Sex of participants, marital status, Educational status, monthly income, Attitude: Participants with score of greater than or equal to 6 attitude questionnaires answered where consider having favorable attitude and those who scored less than 6 attitude questionnaires answered were considered having unfavorable attitude toward COVID-19 (8) . Knowledge: Appropriate responses from nurses about COVID-19 through the structured knowledge questionnaires answered by >=8 correct response from 13 knowledge questions) were considered having good knowledge and those below < 8 correct response from 13 knowledge questions) were considered having poor knowledge (8) . Suspected case of COVID-19: is a person presenting with fever (>38℃) or history of fever and symptoms of respiratory tract illness, e.g., cough, difficulty in breathing, AND a history of travel to or residence in a country/area or territory reporting local transmission of COVID-19 disease during the 14 days prior to symptom onset (1).. Probable case: is a suspect case for which testing for COVID-19 is inconclusive (1). Confirmed case: is a person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms (1). The Data was collected using a pretested and structured Self-administered questionnaire, which was adapted from WHO COVID-19 guidelines, Training manuals and published articles with some modifications to the local context (16) (17) (18) (19) (20) (21) 30) ). The questionnaire was prepared in the English version. The questionnaires addressing provider and institutional characteristics of Nurses; structured questions addressing knowledge of Nurses towards COVID-19 and Likert Scale guide addressing the Attitude of nurses towards COVID-19. A total of seven trained data collectors and three supervisors (who have an experience of data collection done as task force of COVID-19 and Quorante Treatment Center of COVID-19) were select. Two days of training was given for data collectors and supervisors regarding the study purpose, methodology, how to conduct administer self-administered questionnaire, how to take consent, keep confidentiality, and respect the right of the participants. The quality of the data was assured by pretesting of questionnaire on 5% of the sample (9 Nurses) in Bahirdar Felegehiwot Hospital prior to the start of the actual study to test the fitness of the questionnaire for the study settings, based on the result of the pretest, some ambiguous questionnaire will modify for clarity and consistency. Training about the data collection tool as well as data collection procedures (ways of approaching the eligible Nurses and how to obtain permission for Self-Administer Questionnaires) was given to data collectors and supervisors for a total of two days prior to the data collection process. The objectives of the study were clearly explained to the data collectors as well as supervisors. The respondents were to give brief orientation before they are given the Questionnaires and J o u r n a l P r e -p r o o f supervision will be done at the spot by the supervisors. Throughout the course of the data collection, Data collectors were supervised at each site, a regular meeting was held between the data collector's supervisor and the principal investigator to discuss the problem arising in each interview, and detailed feedback was provided to the data collectors. In addition, the collected data was check daily for its completeness, accuracy, and clarity by supervisors. The reliability of the tool was determined based on the analysis result of the pretest which (Cronbach's alpha). The principal investigator checked every questionnaire before data entry. The Data was kept in the form of a file in a private secured place. After checking the completeness of the data, it was entered into Epi info version 7.2.0.1, and then; it was export to SPSS Version 24 for analysis. Descriptive analysis was done by computing proportions and summary statistics. The association between each independent variable and the outcome variable was assessed by using binary logistic regression. All variables with P ≤ 0.2 in the bivariate analysis were included in the final model of multivariable analysis to control all possible confounders. AOR along with 95% CI were computed and P value < 0.05 was considered to declare factors that have statistically significant association with the outcome by using multivariable analysis in the binary logistic regression. The goodness of fit was tested by Hosmer-Lemeshow statistic test. Finally; the result is presented in the form of texts, tables, and graphs. Ethical clearance was obtained from the Ethical Review Committee of Debre Tabor University, Research and Community service Directorate. A letter of permission was given to South Gondar zone health department and Debre Tabor town health office and each hospital. The patient data was assessed up on the approval of the medical director of each hospital. To ensure confidentiality, the respondent identifier was not recorded in the data collection check list, and data was used only for the intended study According to the study, 95 (57.2%) of the participants were Females and 71 (42.8%) were males. and widowed marital status respectively. Regarding monthly income, 100 (60.2%) were >=5000 monthly income, 63 (38.0%) were 3001-4999 monthly income, 3 (1.8%) were <3000 monthly income (Table 1, Figure 3 ). Among study participants,64 (38.6%), 62 (37.3%), and 40 (24.1%) of the study participants had work experience in clinical area 5-10 years, less than 5 years, and greater than 10 years respectively. Majority of study participants 142 (85.5%) were Over worked status per day. In the Source of information on COVID-19, the majority of participants headed from International health organization, e.g., WHO 103 (62%) ( Table 2 ). (Table-3 ). Based on finding, 105(63.3%) of respondents have favorable attitude for COVID-19 whereas the rest 61(36.7%) have unfavorable attitude (Table 4 ). Variables having p-value less than 0.2 during the bi-Variable analysis in the current study and variables considered as significant from other literatures were analyzed; and the multivariable analysis indicated that there was one variable that showed statistically significant with (Table-5 ). Variables having p-value less than 0.2 during the bi Variable analysis in the current study and variables considered as significant from other literatures were analyzed; and the multivariable analysis indicated that there was one variable that showed statistically significant with the Attitude of Nurses toward COVID-19 in south Gondar Hospitals. Strongly agrees Medical staffs are ready to participate in anti-epidemic in the community (AOR =0.08, 95% CI = (0.003-1.76 were factors of attitude about COVID-19 (Table-6 This finding was not supported by the other studies because there is no enough study conducted. It was based on online data collection techniques using email and telegram. Some health workers might not have access to such services due to limited access to technology, internet service and electric power. Thus, they might not be sampled even if they are important to this study. Also, moreover, this study included nurses working only in government health facilities. Because it is a one-time study, it shared the limitations of a cross-sectional study to establish cause-effect relationships. The effect of improving education of personnel and following up the improvement of practices. 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